Music Improves Some Postoperative Outcomes

Diana Phillips

August 14, 2015

Surgical patients who listened to music were significantly less anxious and more satisfied postoperatively compared with those who did not, according to a systematic review and meta-analysis of data from 72 trials. They also needed less pain medication and reported significantly less pain, Jenny Hole, MBBS, from Queen Mary University of London, United Kingdom, and colleagues report in an article published online August 12 in the Lancet.

The analysis included randomized controlled trials that compared any type of music initiated before, during, or after surgery with standard care of other nondrug interventions in adult patients undergoing any form of surgery, excluding central nervous system or head and neck procedures. The outcomes of interest were postoperative pain, analgesia needs, anxiety, infection rates, wound healing, costs, length of stay, and patient satisfaction.

The standardized mean differences in outcomes from the start of the study for anxiety, pain, need for pain medication, and satisfaction in the intervention group relative to controls were, respectively, −0.68, −0.77, −0.37, and 1.09, the authors report. No differences were observed in length of stay, and none of the studies investigated the effects of music on infections, wound healing rates, or costs, they write.

Music played preoperatively was associated with the greatest reduction in pain, analgesia, and anxiety, followed by intraoperative and postoperative music, according to the analysis.

"Music reduced pain, even when given under general anaesthetic, but the intervention had an increased effect on pain when patients were conscious," the authors report.

Nonsignificant reductions in pain and analgesia use were observed among patients who were allowed to choose the music, either from their personal playlist or one that was provided to them. "However, we recorded a slight but non-significant increase in anxiety when patients had a choice of music compared with when they had no choice," the authors note.

"Cognitive activities such as listening to music can affect perceived intensity and unpleasantness of pain, enabling patients' sensation of pain to be reduced," the authors write, suggesting a possible mechanism to explain the effects of music on outcomes. "Another potential mechanism could be reduced autonomic nervous system activity, such as reduced pulse and respiration rate and decreased blood pressure."

On the basis of their findings, the authors believe that "sufficient research has been done to show that music should be available to all patients undergoing operative procedures." Patients should be able to choose the type of music they listen to, but the music must not interfere with the medical team's communications with each other or the patient, they stress.

Paul Glasziou, PhD, from Bond University, Queensland, Australia, agrees, writing in an accompanying comment that "music is a simple and cheap intervention, which reduces transient discomforts for many patients undergoing surgery." He notes that "[a] drug with similar effects might generate substantial marketing."

The complexity of human reaction to music does introduce some uncertainties about its use medically, Dr Glasziou writes. Although the low-cost and improved patient experience "make the question of whether to use music seem obvious," he says, exactly how it should be used is still unclear. "Piped Mozart or Madonna might soothe some and irritate others," he notes.

However, these remaining research questions "should not inhibit implementation of a sensible choice for patients now," he adds. "For my next surgery, I will bring some Mozart and a copy of this systematic review."

The study authors and commenter have disclosed no relevant financial relationships.

Lancet. Published online August 13, 2015 Article abstract, Comment extract

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